I love that you’ve been adding “abnormal” indications, and not just running thru the exam with only the findings from a completely healthy subject.
@DrJamesGill2 жыл бұрын
Well, trying to simulate them anyway
@DrJamesGill2 жыл бұрын
In my “grand plan” for the channel, each examination would be covered three times 1- Demo (most are covered, only a few niche ones left 2- Deep dives - explaining what is going on, and ensuring my headaches remain constant 😊 3 - patient examinations demonstrating pathology - but that will be a difficult one to cover
@richardreece73602 жыл бұрын
I've often thought this- many such videos run through the findings for a fully able and healthy 22 year old.
@DrJamesGill2 жыл бұрын
But at medical school we HAVE to train in normal - it actually annoys the students a little - but we want to normal examination burned into their minds, so when they finally find something abnormal it sticks out like a sore thumb A big part of the education at medical school isn’t being able to immediately say “this is the problem” we’ve loads of resources to help with that. The challenge to being able to pick up an abnormality on someone, especially if that wasn’t expected. We can investigate something if we find it. But if we’re only focusing on what we’ve seen /been taught at “not normal” we can miss things 😊 (It bugged me at med school, but now it makes a lot of sense)
@@DrJamesGill certainly leave these little moments in, they add a touch of character without detracting from what you're teaching
@heymimi2557 Жыл бұрын
Megan's laugh is so adorable!!
@charmingresignation2 жыл бұрын
Just found out I got into medical school (Class of 2026!) and in a strange way, your videos helped keep me distracted during the very long, tedious process. Thanks for all you do, Dr. Gill!!
@DrJamesGill2 жыл бұрын
Magnificent!!! That is great news!! Where will you be studying?
@jasonbutler52262 жыл бұрын
@@DrJamesGill at South Hampton Institute of Technology S.H.I.T.
@charmingresignation2 жыл бұрын
@@DrJamesGill I'm Canadian, so I'm studying here! We're in the middle of a bit of a doctor shortage so I plan on staying put :)
@thelearicist2 жыл бұрын
@@jasonbutler5226 🤣🤣🤣🤣
@patrickansell45332 жыл бұрын
@@jasonbutler5226 South Harmon**
@joshuakuehn2 жыл бұрын
Both the doctor and the patient are attractive as hell and the video is just as equally informative. 10/10 would watch again
@1UPWonders2 жыл бұрын
11:19 - This was unexpected but well composed James
@roberty.9569 Жыл бұрын
I learned a few years ago that one of my legs is shorter than the other. I went so long without knowing that it's essentially permanent. Been wearing a heel lift since and it has made a big difference. Very informative, as always.
@BangerSoundtracks2 жыл бұрын
Glad I discovered your channel. Real and educational forms of ASMR are my favourite.
@itsunity232 жыл бұрын
I’ve always wondered if you’d ever show any tests with abnormal signs in them not just a perfectly fine exam. Really cool Doc !
@DrJamesGill2 жыл бұрын
It is easier to demonstrate on SOME msk exams
@purplatypus74052 жыл бұрын
Keep up the good work Dr. appreciate the insight these provide to us non medical professionals.
@DrJamesGill2 жыл бұрын
👍👍
@thegirlwiththatface2 жыл бұрын
Great video. I love demonstrations of what the red flags would look like in addition to the regular exam. The use of diagrams and other visuals are much appreciated as well!
@DrJamesGill2 жыл бұрын
Red flags are difficult to demonstrate, and honestly I think better to discuss, so that the range of variation and WHY can be covered
@starfishgurl19842 жыл бұрын
Another great informative video as always! I really appreciate these even though I’m not the originally intended audience because they help me understand my own body better and how to pay attention to it if something feels off to seek help before too many problems arise as a result. Walking on my feet all night moving, twisting, bending, and squatting at work unloading trucks and restocking the sales floor at a retail store it’s important that I maintain a healthy range of motion having properly fitted shoes and not over exerting myself using poor posture and these are a great supplementary tool to help ensure that I’m doing that.
@DrJamesGill2 жыл бұрын
👍👍
@thybizzle52782 жыл бұрын
Fantastic for me as a nurse, forever learning from your channel Dr. Gill. These examinations fascinate me.
@DrJamesGill2 жыл бұрын
😊 thanks 😊 Which area in nursing are you?
@denni5aur2822 жыл бұрын
Megan is back, yay!
@rs-cw7bd5 ай бұрын
Excellent hip examination video. Useful to see what an abnormal pathology would look like on exam
@pondwater83932 жыл бұрын
I’m not even planning on going to med school I’m planning to go to veterinary med school but your videos are so interesting and cool!
@DrJamesGill2 жыл бұрын
In times of war vets can work as medics. We cant work as vet! 😊
@arturobandini40782 жыл бұрын
I don't work in a medical field, but these videos interest me. Plus, they improve my knowledge of anatomy!
@DrJamesGill2 жыл бұрын
thanks for joining us 😊
@Everyyoueverymiau2 жыл бұрын
Though I’m just here for the ASMR I appreciate that you show what ist looks like when thinks are wrong. That would help me immensely if I was a medical student.
@DrJamesGill2 жыл бұрын
👍 there has been great feedback on here and I’m trying to adapt to create better videos 😊
@SuperDoNotWant2 жыл бұрын
Funny I've been reading medical reports for years talking about Trendelburg tests etc and I never actually knew what they meant (don't worry, I'm not a doctor or allied health professional). This has been very enlightening.
@DrJamesGill2 жыл бұрын
That’s a great thing to hear! I love it when things come full circle like that 😊
@Wonderlustxx72 Жыл бұрын
Honstly. This is THE BEST examination video. The best part is that you included an illustration about the abnormalities. Keep going please 🙏🏻
@jeffkeith6372 жыл бұрын
Very helpful to have the model demonstrate the movements of a patient with deficiencies. And of course to help we tingleheads. Thank you.
@DrJamesGill2 жыл бұрын
SOME of the simple muscular changes are easy to demo, I’m going to try and add a few more in I think
@sir0nion2 жыл бұрын
6:58 Dr Saul would be proud. You MUST ALWAYS check the leg lengths.
@tavitafish2 жыл бұрын
As someone who always had to have his mom go with him to doctors appointments just so someone could explain what was happening, these have been really helpful for making me not dumb
@DrJamesGill2 жыл бұрын
I’ve been surprised at the patient responses with the videos/ glad they are helpful 😊
@nayhoops84312 жыл бұрын
I came here for ASMR and some light learning and now I'm much more interested in kinesiology. Thank you, Dr. Gill & Co.!
@rafaechizen2 жыл бұрын
Hi Dr. Gill, just a suggestion: Perhaps you could include a bloopers section at the end of each video. Nice video.
@Smartasswhizkid75 күн бұрын
There is. He just doesn't make mistakes
@EMPRESSRA56432 жыл бұрын
Love the videos Dr. G. Please keep them coming! Thank you!
@DrJamesGill2 жыл бұрын
I’ve the Knee anatomy in planning atm
@panayiotissavvas2 жыл бұрын
Love the bloopers you added. Great video Dr.
@Walker.Does.Photography2 жыл бұрын
Another excellent piece of craft from you good sir
@DrJamesGill2 жыл бұрын
Thank you. These longer ones are a challenge, but I think worth it 😊
@Billy-dj8zw2 жыл бұрын
His voice is so soothing and he is so cute.
@donkeydonk1272 жыл бұрын
Sus
@Billy-dj8zw2 жыл бұрын
@@donkeydonk127 Why "sus"?
@Asummersdaydreamer142 жыл бұрын
Lighting is a bit inconsistent in this one (white balance maybe?), but still an interesting and informative video. I like how you all demonstrate what a positive result of the tests look like, if that makes sense. Thanks, Dr. Gill and Megan!
@DrJamesGill2 жыл бұрын
Yes colours seem to have had me here. I *thought* something was slightly off, but couldn’t really be sure - now we know
@timknight78962 жыл бұрын
@@DrJamesGill Now we know
@RileyMadincea2 жыл бұрын
@@DrJamesGill Two potential solutions here for future vids. Either: make sure your camera white balance isn’t set to ‘auto’ (otherwise it will change with the light - eg if the sun is in and out of clouds - but won’t look consistent if/when you cut footage together), OR use colour balance picker tool in colour menu of your editing program (use picker to click on white background and editor should then adjust colour to make everything back to “normal” since it now knows what surface is supposed to be white). If you go for the first option, just play with the white balance presets on your camera until you get an image close to what your eye sees. If it’s not exact, you can always use method 2 to correct in the edit - and at least you’ll only have to do that once (as footage should all be the same colour).
@mara-if3wz2 жыл бұрын
@@joshuavincent7884 how is that not distracting? its pretty obvious and takes away from the experience. you should get your eyes checked
@stankylegg17822 жыл бұрын
Great video, very informative. Thanks to you both for this.
@DrJamesGill2 жыл бұрын
👍
@dareafolabi62 Жыл бұрын
You made it so so so so simple!!!!!!!
@tehflip2 жыл бұрын
Just here for the ASMR. However, I find myself wondering is the right shoulder slightly lower than the left?
@greasydad2 жыл бұрын
This new patient is so chaotic I love her
@asherrodriguez86392 жыл бұрын
she looks really uncomfortable
@iurivanastacio30815 ай бұрын
?
@deaosatori216 Жыл бұрын
I love the mad grading on this video. It's psychedelic!
@DrJamesGill Жыл бұрын
I think it’s a symptom of my colourblindness!
@suhailahmad7944 Жыл бұрын
Well explained, thank you so much..
@DrJamesGill Жыл бұрын
Glad it was helpful!
@emlish2 жыл бұрын
I'd love if you could do a video on how you handle difficult patients - mostly how you don't let it affect you and maintain your mental health as a clinician. I've worked in admin in a GP surgery and a hospital and I don't know how the clinical staff can stand dealing with difficult patients back to back all day long. Even if it's only 1 or 2 rude entitled people in a day, it must grate on you surely?
@DrJamesGill2 жыл бұрын
perhaps, it's a difficult topic however
@d1nonlymsthang2 жыл бұрын
Hi there! I am a follower and watch for ASMR, but I was recently told I have sacroilitis, not sure I spelled that correctly, and was hoping you would have mentioned it since I'm told it affects the hip, pelvic area and makes it very painful and difficult to walk. Do you have any archive videos discussing this issue by chance? Thank you 😊
@DrJamesGill2 жыл бұрын
That was the part where we pressed down on the pelvis to stress the SI joint - as the sacroiliac joints become inflamed with sacroilitis 😊
@spencerbrown35602 жыл бұрын
This is the world's greatest man
@josemerino78942 жыл бұрын
You are the man !!! The 🐐 of doctors💪🙏🔥
@alejandrocastillo57712 жыл бұрын
Great video Dr. Gil, love finding baseline and then showing abnormal findings. We see a lot of falls or lumbar pain that go to our ER, great assessment tool (the video). Thank you from Texas 😎👍
@kazuhiramiller19962 жыл бұрын
Is there any chance that you might do a video about migrane and cluster headaches? I think a lot of people would be interested in it.
@DrJamesGill2 жыл бұрын
It’s on the list, along with a few other things. 😊
@benisaten2 жыл бұрын
First class as always, Dr. Gill 👌 You're a great teacher, my friend. Cheers from Niagara 🇨🇦 ✌️
@andrewalllport40892 жыл бұрын
It’s spelled Nigeria 🇳🇬
@kiarona.2 жыл бұрын
@@andrewalllport4089 seeing as they've put the Canadian flag, and Niagra is a municipality in Canada, I'm pretty sure they know where they live!
@pinraspberry77682 жыл бұрын
@@kiarona. it’s a joke
@Hurtydwarf2 жыл бұрын
Have you ever said your opinions on chiropractic work? A lot of what you went over in this video is stuff I've seen chiropractors like Dr Gregory Johnnson and Dr Brent Binder discuss in their adjustment assessments.
@DrJamesGill2 жыл бұрын
Physiotherapy is very good, and supported by research and evidence.
@liammcgrath23062 жыл бұрын
Even though I’m not a doctor, I’ve spent enough times in hospital and certainly got my moneys worth out of the NHS. I find all of these videos by Dr Gill interesting
@DrJamesGill2 жыл бұрын
Hopefully you have found they helped you understand your body a little better?
@liammcgrath23062 жыл бұрын
@@DrJamesGill yeah. I do have an interest but I’m not clever enough for medical school
@themeez10002 жыл бұрын
I'm not sure if it's in purpose but your videos are very relaxing and ASMR like.
@simpedros47662 жыл бұрын
Yes. Dr gill is an asmr legend on KZbin
@samaiech7587 Жыл бұрын
Hello, Dr. Gill. What exercises would you recommend for weak hip flexors and tight iliopsoas?
@DrJamesGill Жыл бұрын
Honestly, I’d recommend a review with a physio. Whilst I have working knowledge of the musculature, when it comes to rehabilitation, you want to get advised by the experts - physio
@rojayreid9086 ай бұрын
Love to see more Megan in the future❤
@autotopnig14002 жыл бұрын
Awesome detailed video doc! Didn’t want the video to end
@DrJamesGill2 жыл бұрын
👍
@nemec6042 жыл бұрын
I started watching these to fall asleep easier and now I'm addicted :)
@DrJamesGill2 жыл бұрын
Knowledge for the win 😊
@adamwestlund3412 Жыл бұрын
I'm glad to see that Han Solo settled down and got into medicine.
@DanielC010001002 жыл бұрын
Awesome video! Learned a lot
@DrJamesGill2 жыл бұрын
Great to hear! How do you think we could improve?
@chase91722 жыл бұрын
Great, relaxing, informative video. Thanks. Weird side note: This patient looks like the real life version of Aloy from the Horizon video game series to me.
@49ers_red_and_gold22 жыл бұрын
Doctor James 🤩
@paulosborne65172 жыл бұрын
Well, if your patient decides on a career in pro-wrestling, the MC could introduce her as - "Megan 'The Bedbreaker' Struthers".
@coltonpeterson1452 Жыл бұрын
Bed breaker…whadda mean by that brother
@DC-ef8op Жыл бұрын
Can you please recommend anyone in the US that would be a thorough as you?
@The_Omegaman2 жыл бұрын
I feel like a doctor watching these. Then reality hits at end of video.
@psydocthepsyduck83822 жыл бұрын
This is the best! Thank you!!!
@maya511 Жыл бұрын
Have my first osce exam in two weeks. Wish me luck and any advice anyone has for me?
@DrJamesGill Жыл бұрын
Good luck! Anything we can help with in the run up?
@maya511 Жыл бұрын
@@DrJamesGill yes actually!! A video on how to read abdorminal and chest x rays with their common findings and their associated conditions would be very much appreciated!!
@DrJamesGill Жыл бұрын
We’ve got you sorted for a basic approach to CXR, two weeks might be a bit tight for an AXR, but I’ll put it on the list
@supermix43202 жыл бұрын
I'm really thankfull for the knowledge you share with us. It has helped me to be more aware and thankfull that i'm a healthy and a caring "body owner" (probably my encephale talking here idk..😅) The quality of the content is also getting better and wider on every topic. i really had to appreciate that. Thank you Doc! hope you will continue to enlight me with medical science for has much has you enjoy sharing it ! I wish you the best, Signed a knowledge seeker P.s. the bed part with the pause and the laughter was a nice addition to keep in 😁👋👋
@DrJamesGill2 жыл бұрын
It’s a slow journey, but I think I’m getting the hang of it
@carmeloaslanidis25482 жыл бұрын
Another great video! I would recommend however, to manually set your camera's white balance as it seems to change between scenes on an auto setting. Loving the new editing!
@DrJamesGill2 жыл бұрын
Thanks. That’s a good point. I’ll try it
@leecartwright490 Жыл бұрын
Thank you, I have a problem in that area, if I sit at a desk my groin area about waistline burns about skin deep. But if I use a stand up desk the goes much deeper into the hips. Had it 6 months now.
@sonofliberty12 жыл бұрын
Great, informative video as always but; How did you get Zosia Mamet on your Channel?
@nhummm2 жыл бұрын
are you serious?😂
@sonofliberty12 жыл бұрын
@@nhummm No.
@raider58642 жыл бұрын
the legend himself
@markmccallum4752 жыл бұрын
Is it true you're the on set doctor for GI Jane 2?
@95mudshovel2 жыл бұрын
I have no use or application for any of this information since I'm a magnet sculptor and writer but it's midnight right now and I'm doing everything I can not to break my twenty month clean streak from my brutal self-mutilation addiction. I just like feeling as though someone is speaking to me, it keeps me from just screaming into the void. maybe you could talk about how to bring up / address self harm scars (like my train track arm) when first meeting or examining a patient? I've had doctors be extremely kind and others be profoundly rude about them. it occurs to me that there probably isn't any training in this area and doctors are caught just as off guard as strangers who see my scars when I'm out shopping or at the gym except the doctor now has to talk to me and the awkwardness is more impactful to me as a person.
@DrJamesGill2 жыл бұрын
I’m sorry you’ve had this to deal with. Are you getting help from your doctor? When I’m unaware of the situation, I deal with it the same way I would as an unexpected rash “can you tell me about this please?” and carry on from there
@95mudshovel2 жыл бұрын
@@DrJamesGill I'm actually getting shots inside the more hardened ones which is making them flatter and helping the itching. that's nice that you do it like that. I still don't like when people ask about mine, even my therapist doesn't really make me talk about those days. it's _such_ an addictive habit. it gets life / limb threatening quickly.
@finbob3868 Жыл бұрын
I need a compilation of Dr Gill bloopers. Problem is I don't think he makes mistakes
@Flippirino2 жыл бұрын
I guess you could say, you gotta be "hip" to reach the young ones Also, may I ask how are your hips and is there a good way to keep them in check?
@DrJamesGill2 жыл бұрын
Keeping active, and a health weight is probably best advice for hip - and ensuring your shoes are appropriate
@Flippirino2 жыл бұрын
@@DrJamesGill I'll be sure to make sure I'm doing a majority for when I'm active! Thank you James!
@Zure4672 жыл бұрын
I'm 29 and my hip has been screwed up since 24 working at USPS and my knee..and my ankle...and my shoulder..my hand goes numb some times..
@DrJamesGill2 жыл бұрын
Sounds like something in the kinetic chain throwing everything off. You need to see your GP to have that looked at
@Zure4672 жыл бұрын
@@DrJamesGill After watching your video I'm going to. Thank you Dr. Gill.
@epicohuman20472 жыл бұрын
Your videos are life saving. Sir, could you please complete the history taking series as well? Thank you so much
@DrJamesGill2 жыл бұрын
I will try my best
@LaiyaUnscripted2 жыл бұрын
wow i love these videos! informative and comforting!
@DrJamesGill2 жыл бұрын
👍
@Apogenezis Жыл бұрын
Nice video
@L555HEP2 жыл бұрын
I really need to find out if my right leg is longer. When I'm rowing feels like my right is doing all the work and at the end of the stroke my left foot lifts off the foot support as if it's shorter.😞
@DrJamesGill2 жыл бұрын
Easy to measure - just as a friend with a tape measure, and follow as in the video Up to ~ 7-8mm difference is within normal for true leg length
@DrJamesGill2 жыл бұрын
I had similar when I rowed at Warwick, I needed inner soles to fix 😊 - but never made it to the first Viiii though 😞
@L555HEP2 жыл бұрын
@@DrJamesGill Yeah it's weird, feels like my left leg has pushed as much as it can but the right is still going.😀
@neo4016 Жыл бұрын
Bro getting me through med school singlehandly (i dont go to med school)
@kejdzu2 жыл бұрын
How Tall are you James, which specialty did you finish?
@DrJamesGill2 жыл бұрын
I’m trained as a GP - so I know a little about a lot, but not a lot about many things
@kiely45612 жыл бұрын
A Jack of all trades is a master of none, but often times better than a master of one
@rojayreid9089 ай бұрын
She is a regular, good to see her more.😅😊
@simondb992 жыл бұрын
Megan looked really worried when you said it's not just a concern for older people 😂 0:17
@DrJamesGill2 жыл бұрын
You may be surprised how often young sports people injure their hips
@derrickw52042 жыл бұрын
@@DrJamesGill Buster Posey , a well known All Star catcher for the San Francisco Giants had hip problems that eventually ended his baseball career last year . National Hockey League players here in North America and Canada are allowed to hit or " check " an opposing player by ramming their shoulder into the other player's hip to get them to " straighten up " .
@Omfgwhtavid2 жыл бұрын
(As a patient) Can you do anything about that Anterior Tilt? I’ve got that and it causes me lower back problems
@gigantor562 жыл бұрын
When my daughter was born they said she had hip dysplasia. This was diagnosed just after birth. She had a "harness" that she had to wear and we were given instructions on how to exercise her legs and hip. I believe we only did this for the first year of her life. She is now 19 and notices some uncomfort with her hips.
@DrJamesGill2 жыл бұрын
That’s a Plavic harness and they look almost medieval - but they work If she is having difficulties, it would be worth talking to her GP she may need a chat with a specialist 😊
@emilychilds95512 жыл бұрын
Oh I had one of these as a baby!! I keep getting told my hips should be better than normal now but they keep pulling out slightly. Glad I'm not alone!!
@Dukuduu_2 жыл бұрын
Thank you for the revision. :))
@theharris72072 жыл бұрын
This is the 2022 equivalent of reading an encyclopedia in bed
@DrJamesGill2 жыл бұрын
Interesting take!
@Kat444-r1h2 жыл бұрын
I'm 41 and cant lay on my hip,its do painful,its been like it for months.My mum and her sister both have osteoporosis
@701raghavsethi5 Жыл бұрын
Thankssss❤
@alistairreed35142 жыл бұрын
hey doctor doctor how are you today
@markwagner49092 жыл бұрын
I had to have both my hips replaced because of a tear in something I don’t know what I did on the first hip to cause a tear but the second one I was stepping over a puddle getting into my car and knew immediately something happened (based on my first hip replacement) The replacements were the best thing ever. I was a runner for years but as I age running turned into walking
@DrJamesGill2 жыл бұрын
It’s amazing what the orthopods can do. Was that a labral tear?
@bigbogmangoman26582 жыл бұрын
11:23 😂😂
@DrJamesGill2 жыл бұрын
I think that should have been edited out! 😅
@petrapetkova12442 жыл бұрын
I'm glad you haven't edited it out, it made me giggle 😂
@AL-jo2vp2 жыл бұрын
@@DrJamesGill it does briefly break ASMR but I think seeing this occasionally is quite funny. A blooper reel compilation now and again would be a great addition
@gizzems-29032 жыл бұрын
Megan during intro : *thinking* “what a splendid wall”
@DrJamesGill2 жыл бұрын
🤣
@Loonyrabbit-tv2 жыл бұрын
Having done our (stares ) having broken the bed ) 😂😂😂😂😂
@DrJamesGill2 жыл бұрын
Yes that slipped through the edit. Would fire the editor, but that would cause problems
@ashishdevadig28352 жыл бұрын
@@DrJamesGill noooo, give him a raise instead.
@thelearicist2 жыл бұрын
@@DrJamesGill glad it slipped through
@LeKnightStudios134192 жыл бұрын
I presume Megan will be the new Abbie Tutt for the time being?
@DrJamesGill2 жыл бұрын
I’m lucky that we have three students who are working with me at the moment
@LeKnightStudios134192 жыл бұрын
@@DrJamesGill Must be a good thing that students are enthused to work w u
@alphacentauri60272 жыл бұрын
Not just that you wonderfully explains the stuff but the charisma you have while delivering it is exceptional. Great work. #bigfan . What's up doc? Doc be like:- let's put a bit of paper. 🥰🥰. Master ASMR too. One and only doctor Gill.❤
@klefdnb2 жыл бұрын
-Please, relax -I am relaxed -I'm talking to myself
@mollystroud67832 жыл бұрын
this video is making me realize why i’m studying law 😂 would never be able to remember all the terminology 😂
@DrJamesGill2 жыл бұрын
Actually I’ve been told law and medicine have a similar level of vocabulary to learn.
@Cornelius711765 ай бұрын
Lucky doc.
@frankdrevin44502 жыл бұрын
Hope the bed still ok... These are not times to spend money in new beds, gotta learn to repair them
@DrJamesGill2 жыл бұрын
Touch and go, but it survived
@harkas64842 жыл бұрын
İ wish i can understand i need improve my English but i like accent and your soft speaking make me a sleepy 😴😴
@UNAI.EMERY.2 жыл бұрын
Wish physio actually did this instead they just ask you 5 questions and not diagnose you and just throw you some basic exercises from the printer. Even if they don't know what's wrong
@stevewilson97782 жыл бұрын
I know that it's crazy I know that it's nowhere But there is no denying that It's hip to be square
@fazlurahman51032 жыл бұрын
u have interchanged apperant lenght instead of true and true instrad of apparent
@victoria-ik2le2 жыл бұрын
THIC CHAIN
@paisan87662 жыл бұрын
Definitely plenty of hips to observe on this patient